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Anatomy Test 3 > Cervical Region > Flashcards

Cervical Region Flashcards

1
Q

What are the bones of the neck?

A
  • Cervical vertebrae C1-C7
  • Manubrium of sternum
  • clavicles
  • hyoid bone
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2
Q

Defining features of hyoid bone?

A
  • MObile
  • Level of C3
  • Greater and lesser cornu/horns
    • landmark for administering sup laryngeal block for awake fiberoptic
  • serves as attachment for anterior prop to keep airway patent
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3
Q

What is the superficial cervical fascia?

A
  • Subcutaneous tissue of neck between dermis and deep cervical fascia layer
  • cutaneous nerves, blood, lymph vessels, fat
  • Platysma
    • thin, superficial muscle of facial expression
    • CV VII
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4
Q

What is the deep cervical fascia?

A
  • Three fascial layers
    • investing
    • pretracheal
    • prevertebral
  • Allows structure to smoothly slide past each other
    • i.e. swallowing, turning head
  • allows for separation of structures during surgery
  • supports viscera, muscles, vessels, deep lymph nodes
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5
Q

What si the investing layer?

A
  • Surrounds entire neck deep to skin and subcutaneous tissue
  • encloses sternocleidomastoid muscles and trapezius muscles
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6
Q

What is the pretracheal fascial alyer?

A
  • Muscular part
    • infrahyoid muscles (encloses muscle)
  • visceral part
    • encloses thyroid gland/parathyroid, trachea, esophagus
  • Carotid sheath
    • common and internal carotid arteries
    • IJ vein
    • vagus nerve
    • carotid sinus nerve (from glossopharyngeal nerve- nerve of Herring)
    • sympathetic fibers(carotid periarterial plexuses but NO cervical ganglion/trunk)
  • role in infections and extravasated blood
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7
Q

What is the prevertebral layer?

A
  • Tubular sheath for the vertebral column and the muscles associated with it
    • longus colli, longus capitis
    • scalenes
    • deep cervical muscles
  • Retropharyngeal space
    • potential space b/w visceral part of prevertebral layer to buccopharyngeal fascia
    • permits mvmt of pharynx, esophagus, larynx, trachea relative to vertebral column during swallowing
    • major pathway for spread of infection
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8
Q

What is innervation/action of sternoclediomastoid?

A
  • Action: unilateral: lateral flexes neck turning face superiorly toward opposite side
    • bilateral extends neck at atlantooccipital joints
    • flexes cervical vertebrae so chin approaches manubrium or
    • extends superior cervical vertebrae while flexing inferior vertebrae so chin is thrust foward with head keep level
    • assists with deep respiration
  • Innervation- spinal accessory nerve (CN XI) for motor
    • c2/c3 for pain/proprioception
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9
Q

What is action/innervation of mylohyoid?

A
  • Action: elevates hyoid, floor of mouth, and tongue with swallowing and speaking
  • Innervation: nerve to mylohyoid, branch of CNV3
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10
Q

What is A/I geniohyoid?

A
  • Action: pulls hyoid anterosuperior; shortens floor of mouth; widens pharynx

Innervation: C1 via hypoglossal nerve (CN XII)

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11
Q

What is A/I stylohyoid?

A
  • Action: elevates and retract hyoid; thus elongating floor of mouth
  • Innervation: stylohyoid branch of facial nerve (VII)
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12
Q

What is a/i of digastric?

A
  • Action: working with infrahyoid muscles, depresses mandible, elevates and steadies hyoid with swallowing and speaking
  • Innervation
    • anterior belly: nerve to mylohyoid, branch of CN V3
    • Posterior belle: digastric branch of facial nerve )CN VII)
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13
Q

What muscles make suprahyoid muscles?

A

Mylohyoid

Geniohyoid

Stylohyoid

Digastric

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14
Q

What are the infrahyoid muscles?

A

Sternohyoid

Omohyoid

sternothyroid

Thyrohyoid

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15
Q

A/I of sternohyoid?

A
  • Action: depresses hyoid after elevation durign swallowing
  • Innervation: C1-C3 ansa cervicalis
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16
Q

A/I Omohyoid?

A
  • Action: depresses retracts and steadies hyoid
  • Innervation: C1-C3 ansa cervicalis
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17
Q

A/I Sternothyroid?

A
  • Action: depresses hyoid and larynx
  • Innervation: C2 and C3 ansa cervicalis
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18
Q

A/I Thyrohyoid?

A
  • Action: depresses hyoid and elevated larynx
  • Innervation: C1 via hypoglossal nerve
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19
Q

A/I Anterior scalene?

A

Action: flexes neck laterally; elevates 1st rib during forced inspiration

Innervation: cervical spinal nerves C4-C6

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20
Q

What is /AI of middle scalene?

A

ACTION: flexes neck laterally; elevated 1st rib during forced inspiration

INNERVATION: Anterior rami of cerivcal spinal nerves

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21
Q

Pathway of CNXI?

A
  • Deep to SCM as it supplies the muscle
  • Deep to investing layer of deep cervical fascia
  • deep to trapezius and pierces muscle
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22
Q

Branches of cervical plexus?

A
  • Anterior rami C1-C4
  • Cutaneous branches emerge posterior border of SCM
    • Transverse cervicla nerve (C2,C3)
    • Great auricular nerve (C2,C3)
    • Supraclavicular nerves (all sensory)
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23
Q

What is the nerve point of the neck?

A
  • A cervical plexus block
  • done for CEA’s
    • preffered anesthestic technique is awake, that way if they lose consciousness when carotid clamped, then you know they need a bypass
  • Provide anesthesia to anterolateral neck, superolateral thoracic wall, and scalp b/w auricle and external occipital protuberance
  • may temporarily paralyze the trapezius and +/- SCM
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24
Q

What forms the cerivcal plexus?

A
  • Series of nerve loops form anterior rami of C1-C4
  • Anteromedial to elvator scapulae and middle scalene muscle; deep to SCM
  • Superficial branches are cutaneous
    • lesser occipital, transcervical, supraclavicular
  • deep branches motor
  • receives communicating branches from superior cervical ganglion (sympathetic nerves)
  • forms ansa cerivcalis
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25
Q

What forms the ansa cervicalis?

A
  • Superior root
    • C1 and hypoglossal nerve
    • superior belly of omohyoid
  • Inferior root
    • C2 and C3
    • Sternothyroid
    • Sternohyoid
    • Inferior belly of omohyoid
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26
Q

What are the additional branches of cervical plexus?

A
  • Lesser occipital nerve (C2)- Skin of neck and scalp to posterosuperior to auricle
  • Great auricular nerve- C2&C3- Skin of posterior aspect of auricle, angle of mandible, and mastoid process
  • Transverse cervical (C2&C3)- Skin of anterior cervical region
  • Supraclavicular nerve (C3&C4)- Skin of neck, clavicle and shoulder
  • Phrenic nerve (C3-C5; Mainly C4)
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27
Q

What is the phrenic nerve?

A
  • FOrms on atnerior scalene muscle at the level of the superior border of the thyroid cartilage
  • Passes anterior to anterior scalene, in front of SCL argery, behind SCL vein, under clavicle, on top of pericardium and inot diaphragm
  • Motor and sensation to diaphragm
  • sensation to mediastinum pleura and pericardium
  • receives sympathetic communicating fibers from cervical sympathetic ganglia
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28
Q

Role of hypoglossal nerve and cerivcal plexus?

A
  • Somatic motor to extrinsic muscles- styloglossus, hyoglossus, genioglossus (Except palatoglossus)
    • also intrinsic muscle of tongue via lingual branches
  • Provides superior root to ansa cervicalis to supply infrahyoid muscles
  • exits via hypoglossal canal
  • pathway deep to mylohyoid muscle
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29
Q

Glossopharyngeal pathway/innervation throughout cervical region?

A
  • Exits via jugular foramen
  • Somatic motor to stylopharngeus muscle to assist with swallowing, responsible for gag reflex (sensory)
  • Visceral motor- PSNS innervation to parotid gland via otic ganglion
  • Special sensory- taste post 1/3 of tongue
    • cell bodies in superior and inferior ganglia
  • Gen somtic sensory to- external ear, pharynx, middle eat
    • cell bodies in sup and inf ganglia
  • Visceral sensory to carotid body and sinues
    • cellbodies in sup and inf ganglia

Passes deep in neck to hyoglossus muscle

30
Q

What is role of vagus nerve? Location in cervical region?

A
  • Exits via jugular foramen
  • Somatic motor- constrictor muscles of pharynx, intrinsic muscles of larynx, muscle of palate (except tensor veli palatini) and striated muscles of sup 2/3 esophagus
  • Viscerla motor- PSNS to smooth muscle trachea, bronchi, digestive tract and cardiac muscle of heart
  • Visceral sensory- base of tongue, pharynx, larynx, tachea, bronchi, heart, esophagus, stomach, intestine
  • Special sensory- tast from epiglottis and palate
  • Gen somatic sensation-auricle, external acoustic meatus, and dura mater of posterior cranial fossa

Passes through posterior aspect of carotid sheath- behind internal carotid and jugular vein

31
Q

The left and right vagus nerves give rise to ____ ___ nerves

A

superior larngeal nerves

  • have internal and external laryngeal divisions; level of greater cornu
32
Q

Right vagus nerve passes ____ to first part of SCL artery, _____ to the brachiocephaliv vein and SC joint

A

anterior; posterior

33
Q

What comes off right vagus nerve>

A

Right recurrent larngeal nerve

  • Loops inferior to right SCL artery and ascends
34
Q

Left vagus nerve descends between the __- ___ ___ and the ___ ___ ___ and posterior to SC joint

A

left common carotid; left subclavian arteries

35
Q

What comes off left vagus nerve?

A

gives off left recurrent larngeal nerve

  • Loops inferior to the arch of the aorta and ascends
36
Q

What does the external laryngeal nerve innervate?

A

Cricothyroid

37
Q

Why would a patient with aortic aneurysm have a hoarse voice?

A

Stretching of left recurrent larngeal nerve by aneurysm causing hoarseness of voice.

38
Q

There are no ____ rami communicantes in neck

A

white

39
Q

Pathway sympathetic nervous system in neck?

A
  • Presynaptic fibers conveyed to sympathetic trunk by superior thoracic spinal nerves and white rami communicates
  • SYnapse in cervical ganglia
  • postsynaptic ganglia send fibers to
    • cervical spinal nerves via gray rami communicates
    • thoracic viscera via cardiopulmonary splanchnic nerves
    • head and viscera of neck via cephalic arterial branhces (vertebral and internal, external carotid arteries) as the sympathetic periarterial plexuses
40
Q

What is the inferior cervical ganglia?

A
  • Stellate ganglion
  • site for cervicothoracic ganglion block
    • anesthesia for vascular spasms of brain and upper limb
41
Q

What is horner syndrome?

A
  • Pupillary constriction
  • ptosis (drooping of eyelid)
  • enopthalmos (sinking in of the eyeball)
  • anhidrosis (loss of sweating) and vasodilation of face and neck

This occurs because of parasympathetic nervous system taking over d/t blocking of sympathetic response c interscalene block.

42
Q

What is first branch off of the aorta?

A
  • Brachiocephalic trunk
    • first banch of aorta
    • divides into right common carotid and right subclavian
    • supplies right side cervical arteries
43
Q

What arteries come off of right subclavian?

A
  • Anterior scalene divides into three parts
    • 1st: medial to anterior scalene
      • vertebral artery, internal thoracic artery, thyrocerical trunk
    • 2nd: posterior to anterior scalene
      • costocervical trunk (ribs)
    • 3rd: lateral to anterior scalene
      • dorsal scalpular artery
44
Q

What forms roots of cervical arteries on left side?

A
  • Left common carotid artery
    • second branhc of aorta
  • Left subclavian artery
    • third branch of aorta
    • anterior scalene divides into 3 parts
      • 1- medial to anterior scalene
        • vertebral artery
        • internal thoracic artery
        • thyrocervical trunk
      • 2- posterior to anterior scalene
        • costocervical trunk
      • 3- lateral to ant scalene
        • dorsal scapular artery

more or less same as right side

45
Q

What are the major arteries of the cervical region?

A
  • Vertebral arteries
  • common carotid arteries
46
Q

What are the vertebral arteries?

A
  • Foramina of the transverse rpocesses of the vertebrae (C1-C6)
  • Enters cranium through foramen magnum
47
Q

What are the divisions of the common carotid?

A
  • Internal carotid arteries
    • no cervical branches–> goes straight up to head to provide circulation to circle of willis
    • enter cranium through carotid canals
    • main arteries of brain and structures in the orbits
  • External carotid arteries
    • supply most structures external to cranium
    • terminal branches
      • maxillary
      • superficial temporal arteries
      • superior thyroid artery
48
Q

What is the carotid body?

A
  • Medial (deep) side of the bifurcation of common carotid
  • carotid branhc (sinus nerve of hering) of glossopharngeal nerve (IX), vagus (X), and superior cervical ganglion
  • chemoreceptor monitors level of oxygen in blood (po2)
  • low levels of oxygen stimulate a reflex that increases rate/deep of respiration, cardiac rate and BP
49
Q

What is the carotid sinus?

A
  • Bifurcation of common carotid- slight dilation
  • carotid branch (sinus nerve of hering) of glossopharngeal nerve (IX), Vagus nerve (x), and superior cervical gnaglion
  • baroreceptor
    • stimulated by increase in arterial BP results in decrease of HR and SVR
50
Q

Pathway of external jgular vein?

A
  • Begins near angle of mandible
  • terminates in SCL vein
  • receives blood from cervicodorsal, suprascapular and anterior jugular veins
    • some facial, mostly head/neck drainage
51
Q

Pathway IJ vein?

A
  • Receives drainage from brain, anterior face, cervical viscera, deep muscles of neck
  • jugular foramen to subclavian vein within carotid sheath
  • lateral to carotid artery and CN X
52
Q

Pathway of subclavian vein?

A
  • Anterior to anterior scalene and phrenic nerve
  • Joins IJV and EJV to form brachiocephalic vein–> SVC
53
Q

Where is thyroid gland located?

A
  • Deep to sternothyroid and sternohyoid
  • Level of C5-T1
  • left and right lobes
  • two main arteries
    • Superior artery (branch of external carotied)
    • inferior artery (branch of thyrocervical trunk) artiers
      • need smooth, easy wakeup for patient. may rupture arteries with bucking wake up, causing compression of trachea
  • Nerves are derived from cervical sympathetic ganglia
    • vasomotor
    • endocrine secretion regulated by pituitary gland
54
Q

Where is parathyroid gland?

A
  • Lie external to thyroid capsule on posterior aspect
  • typically four parathyroid glands
  • nerves are derived from cervical sympathetic ganglia
    • vasomotor
    • endocrine secretion regulated by pituitary gland
55
Q

What does esophagus muscle consist of? What innervates it?

A
  • VOluntary, striated, muscle in upper 1/3
  • involuntary, smooth muscle in lower 1/3
  • mix of both in middle 1/3
  • Inferior pharyngeal constrictor muscle creates superior esophageal sphincter
  • Nerve supply
    • superior half: sensory and somatic motor via recurrent larngeal nerve of vagus
    • inferior: PSNS innervation and sensory by vagus nerve, vasomotor fibers by cerivcla sympathetic tunks
56
Q

A/I of occipitofrontalis

A
  • Action: elevates eybrows, wrinkles skin of forehead
  • innervation: facial nerve
57
Q

A/I orbicularis oculi?

A

Action: closes eyelids; orbital sphincter

Innervation: facial nerve

58
Q

A/I orbicularis oris?

A

Action: closes mouth, compresses and brotrudes lips

Innervation: facial nerve

59
Q

A/I buccinator

A

Action: presses cheek against molar teeth; works with tongue to keep food b/w occlusal surfaces; cheek muscle

Innervation: facial

60
Q

A/I platysma muscle?

A

Action: depresses mandible, tenses skin of inferior face and neck

innervation: facial nerve

61
Q

What are the six motor nerve branhces of facial nerve?

A
  • Posterior auricular branch
  • temporal branch (nerve stimulator)
  • zygomatic
  • buccal
  • mandibular
  • cervical

Bell’s palsy results in unilateral paralysis of some or all of the muscles on affected side

62
Q

What are cutaneous innervation to face and scalp?

A
  • Anterior to auricle is by 3 division of trigeminal nerve
    • V1- opthalmic
    • V2- maxillary
    • V3- mandibular
      • trigeminal neuroalgia- excruciating facial pain, thought ot be cuase by vessel that compresses sensory root of V
  • Posterior to auricle is by spinal cutaneous nerves
    • Greater and third occipital nerves (posterior rami C2, c3)
    • Great auricular nerve and lesser occipital (anterior rami C2, C3)
63
Q

What provides superficial vasculature to face and scaplp?

A
  • Great variability and anastomosis
  • most superficial artieries of face arise from external carotid artery
    • except supratrochlear and supraorbital arteries which arise from itnernal carotid artery
  • Majority of facial veins drain into the IJ vein
  • auricular and post-auricular regional veins drain into external jugular vein (posterior)
64
Q

Majority of facial veins drain into ____ ____

A

IJ vein

65
Q

Auricular and post-auricular regional veins drain into the ___

A

external jugular vein (posterior)

66
Q

How is parotid gland innervated?

A

CNIX via otic gland

However, facial nerve, external arotid artery and retromandibular vein go right through parotid

67
Q

What are the muscles of mastication? All innervated by?

A
  • Temporalis
  • Masseter
  • Lateral pterygoid
  • Medial pterygoid

All innervated by V3 provide muscles of mastication

68
Q

What is contained in infratemporal fossa?

A
  • Maxillary artery- branch of external carotid artery
  • V3
    • general somatic sensory from skin over mandible, lower lip, side of head, mandibular teeth, TMJ, mucosa of mouth and ant 2/3 tongue
    • somatic motor to muscle of mastication
  • Chorda tympani nerve
    • facial nerve (VII)
    • Joins with lingual nerve of CN V3
    • Taste ant 2/3
    • presynaptic PSNS fibers for submandibular/sl glands via submandibular gnaglion
69
Q

Role of V3?

A

V3

  • general somatic sensory from skin over mandible, lower lip, side of head, mandibular teeth, TMJ, mucosa of mouth and ant 2/3 tongue
  • somatic motor to muscle of mastication
70
Q

Role of chorda tympani nerve?

A

Chorda tympani nerve

  • facial nerve (VII)
  • Joins with lingual nerve of CN V3
  • Taste ant 2/3 tongue
  • presynaptic PSNS fibers for submandibular/slublingual glands via submandibular ganglion
71
Q

Which are of facial vasculature is not provided by external carotid artery?

A

supratrochlear and supraorbital arteries which arise from internal carotid artery

Anatomy Test 3 (2 decks)

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